Well-developed cutaneous feeder compression using a circular plastic disc and a rubber band for embolization of non-sinus type parasagittal dural arteriovenous fistula.

Abstract

Background: Non-sinus type parasagittal dural arteriovenous fistula (DAVF) is associated with a high incidence of cortical venous reflux and is susceptible to the development of progressive symptoms, including venous infarction and cerebral hemorrhage. Well-developed superficial temporal arteries (STAs) and/or occipital arteries (OAs) are frequently involved, which present a challenge in controlling liquid embolic material when injecting liquid embolic material from the middle meningeal artery (MMA). We developed a method to control the feeding from cutaneous vessels using a circular plastic disc and a rubber band.

Case description: We present a case of a 48-year-old male with upper and lower extremity paralysis and diminished sensation in the left lower extremity. Imaging studies revealed a non-sinus type parasagittal DAVF (Borden type III, Cognard type IV) with bilateral MMAs and transosseous feeders from the STA and OA. To control blood flow from cutaneous feeders during Onyx embolization, we used a circular plastic disc and a rubber band to compress the feeders. The DAVF was successfully occluded without any complications. Cutaneous vessels were preserved after embolization.

Conclusion: Our technique, which employs a circular plastic disc and rubber band to physically compress the cutaneous feeders and regulate blood flow during transarterial embolization for non-sinus type parasagittal DAVF, represents a valuable approach to preserving the cutaneous vessels and promptly assessing complete occlusion following the procedure. At the same time, it avoids the potential risks of radiation exposure to the surgical assistant.